#110 Noncontraceptive Uses of Hormonal Contraceptives

Question 1

What percentage of US women will use hormonal contraception during their reproductive years?

Answer 1

> 80%

Question 2

In combined hormonal contraceptives, what is the role of the progestin and what is the role of the estrogen?

Answer 2

Progestin provides contraceptive effects. Estrogen stabilizes endometrium and reduces unwanted spotting.

Question 3

Which progestins in COCs have antiandrogenic properties?

Answer 3

Drospirenone and cyproterone acetate

Question 4

Which type of COC best prevents the development of benign ovarian cysts?

Answer 4

High-dose monophasic preparations (compared to low dose and triphasic)

Question 5

What are some non contraceptive benefits of OCPs and contraceptive patch

Answer 5

regulate and reduce bleeding, diminish dysmenorrhea, improved acne

Question 6

True or false, extended cycle patch can be used to reduce menstrual cycle-related side effects such as menstrual migraine?

Answer 6

True

Question 7

What noncontraceptive benefits does the levonorgestrel IUD have?

Answer 7

Decreased menstrual bleeding and dysmenorreha. Effective for decreasing menstrual blood loss in idiopathic menorrhagia, adenomyosis, leiomyomas, pain d/t endometriosis, and hemostatic disorders

Question 8

What causes dysmenorrhea?

Answer 8

Pain resulting from intense uterine contractions that are triggered by release of endometrial prostaglandins

Question 9

Which hormonal contraceptives are beneficial for treatment of dysmenorrhea?

Answer 9

COCs (relieve symptoms in up to 70-80% of women), vaginal ring, Progestin implant (nexplanon), levonorgestrel IUD

Question 10

What hormonal contraceptives have shown to be effective in reducing endometriosis pain?

Answer 10

COCs, DMPA, progestin contraceptive implant, levonorgestrel IUD

Question 11

What is the reduction in menstrual blood loss in women taking cyclic COCs?

Answer 11

Reduced by 40-50%

Question 12

What is rate of amenorrhea after 12 months of levonogestrel IUD?

Answer 12

20-80%

Question 13

Is the levonorgestrel IUD or COCs more effective for treatment of heavy menstrual bleeding?

Answer 13

Levonorgestrel IUD

Question 14

Is endometrial ablation or levonorgestrel IUD better at reducing menstrual blood loss up to 24 months?

Answer 14

Similar reduction

Question 15

How common is premenstrual dysphoric disorder?

Answer 15

Affects 3-5% of reproductive aged women

Question 16

Which progestin has been associated with improvement in premenstrual dysphoric disorder?

Answer 16

Drospirenone

Question 17

How many women experience menstrual migraines?

Answer 17

8-14%

Question 18

When do menstrual migraines occur?

Answer 18

At the time of menstruation, otherwise free of migraines, with exception of small percentage with migraine at time of ovulation

Question 19

What can be hormonal option can be used for women with menstrual migraines?

Answer 19

Extended cycle or continuous COCs

Question 20

Which hormonal contraceptives are effective for treatment of hirsutism and acne?

Answer 20

All COCs have the potential. Some trials show superiority of antiandrogenic progestins (drospirenone or cyproterone acetate)

Question 21

Mechanism of action that COCs improve acne/hirsutism?

Answer 21

Increase sex hormone binding globulin and suppress LH-driven ovarian androgen production, decreasing levels of free androgen

Question 22

Does the use of COCs decrease risk of endometrial cancer?

Answer 22

Yes, by 50%. Longer durations of use were associated with greater decrease in risk. Effect lasts up to 20 years.

Question 23

Does depot medroxyprogesterone acetate reduce the risk of endometrial cancer?

Answer 23

Yes

Question 24

In what percentage of cases of endometrial hyperplasia without atypia does the levonorgesterel IUD cause regression?

Answer 24

96%

Question 25

Does the levonorgesterel IUD protect the endometrium in women taking tamoxifen?

Answer 25

Yes

Question 26

Does the use of COCs decrease the risk of ovarian cancer?

Answer 26

Yes, by 27%. The longer the use, the greater the risk reduction

Question 27

Does the use of COCs decrease the risk of colorectal cancer?

Answer 27

Yes, by 18%. Greatest reduction for recent use and no duration effect

Question 28

Does use of COCs hasten the resolution of functional ovarian cysts compared to expectant management?

Answer 28

No

Question 29

What effects do COCs have on leiomyoma formation and growth?

Answer 29

Unknown

Question 30

In which population does use of COCs preserve bone mass where non users lost BMD?

Answer 30

Perimenopausal and postmenopausal women

Question 31

Is DMPA associated with increased risk of low BMD compared to peers?

Answer 31

No, can have lower BMD during use, but is rapidly recovered after discontinuation